Provider Demographics
NPI:1275562498
Name:SIOUX FALLS CHIROPRACTIC PROF L L C
Entity Type:Organization
Organization Name:SIOUX FALLS CHIROPRACTIC PROF L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICW MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-338-5511
Mailing Address - Street 1:830 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6028
Mailing Address - Country:US
Mailing Address - Phone:605-338-5511
Mailing Address - Fax:605-339-0265
Practice Address - Street 1:830 E 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6028
Practice Address - Country:US
Practice Address - Phone:605-338-5511
Practice Address - Fax:605-339-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1085111N00000X
SD947111N00000X
SD730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40515Medicare PIN